Reversible intrahepatic cholestasis in metastatic prostate cancer: An uncommon paraneoplastic syndrome

Abstract

Abstract.As with other genitourinary malignancies, a variety of paraneoplastic syndromes have been revealed to occur in patients with prostate cancer. Stauffer's Syndrome is a well-described clinical syndrome which manifests via intrahepatic cholestasis in patients with renal cell carcinoma. Less common is intrahepatic cholestasis occurring in association with prostate cancer. The current case report discusses a 67-year-old man presenting with liver failure secondary to intrahepatic cholestasis co-existing with metastatic prostate adenocarcinoma. The patient's liver failure completely resolved with androgen-deprivation therapy suggesting an association between these two entities. The case report evaluates existing literature on this uncommon syndrome including the clinical presentation, natural history, and potential pathophysiology.

A rare case of idiopathic cholestasis: Clinical conundrums complicating enzalutamide therapy in metastatic prostate cancer

“…PnC is an uncommon and a potentially underrecognized manifestation of PCa. In almost all reported cases, PnC emerged with newly established PCa or progression of known disease; it is often reversible without a known prognostic value . In this case, PnC began with biochemical disease progression and coincident with initiation of enzalutamide, masquerading as a drug‐related event (Figure).…”

“…The differential diagnoses for cholestatic jaundice in this patient broadly include hepatobiliary obstruction—from metastatic infiltration, gallstones, or pancreatic cancer—and systemic etiologies like drug reactions, infections and autoimmune disorders. Very rarely, idiopathic cholestasis can be a paraneoplastic phenomenon in PCa …”

“…Prostate cancer (PCa) rarely manifests with paraneoplastic cholestasis (PnC), a nonmetastatic liver dysfunction that occurs in malignancy without direct hepatobiliary obstruction or hepatic infiltration . Uncommon and underrecognized entities like PnC hold potential implications for clinical management.…”

A patient with obstructive jaundice secondary to intrahepatic bleeding caused by prostate cancer metastasis

“…hemoperitoneum is a life-threatening condition and mandate urgent surgical intervention. 2 To the best of our knowledge, Intrahepatic prostate cancer metastasis associated with intraparenchymal hemorrhage causing cholestasis has never been reported. We present a case with Large subcapsular hepatic hemorrhage by prostatic cancer metastasis causing cholestasis that was treated conservatively.…”

“…1 Cholestasis also can be seen as paraneoplastic manifestation of variant malignant diseases. 2 On rare occasions, spontaneous rupture of liver metastasis causing…”